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CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WO X NOTED. THIS PERMIT COVERS WORK TO
t 0 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON T EPU LID
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DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILLREOLURE
SEPARNrEPEFIMISSION.
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PERMITAPPLICATION; INDAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 'So DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLI ANN, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chit. Deposit
IN INTCEREST, AGREES TO INDEM IFY, DEPEND AND HOLD HARML�SS THE CITY OF
SHINGTON.
2 EDMONDS, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
I ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
2 FROM THE ISSUANC OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Total Amt. Due
9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp.
or N OR LIMIT IN ANY WAY THE C WS ABILITY TO ENFORCE ANY ORDINANCE PROVISRON.w Recording Fes Receipt #
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS COR ECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
IT This application I,md a permit until signed by Me
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL
TION; AND IyOINTH1H1'WOR1.AU.TRORjZ SON WILL BE EMPLOYED Building Offi-1.1 .1 hisle, Deputy: ad Face Me paild, and
IN VIOLATIC OF E N- RELATING TO FOR INSPECTION receipt I..cka.wl.dgad maps. re.W.d.
WORKMENS OMPENSATIOI�L�SUR31X DATE
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771-0220 1 A,
RELfA§ED By !AbATE
ENTION EXT 1333 _I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORGNAL-FILE YELLOW � INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 P�NK-OVVNER GOUD-ASSESSOB
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ...........
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Pier/Porch .................
Retaining Wall
Stab Insulation
PLUMBING:
Underground .............
0 R11
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Rough -in ................
0
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HEATING:
Gas Test ....................
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Gas Piping ..............
Equipment ............
Commercial Final
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0
EXTERIOR SHEATHING
0
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NAILING ........................
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FRAMING ........................
Q 0
FIRST FLOOR, FRAMING
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INSULATION ...................
Floor Insulation
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Wall Insulation ...........
3:
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................